Make no bones about it: Strong bodies require the proper building blocks, the right fuel

Stamford (Conn.) Advocate/Greenwich Time—May 16, 2012

After about seven years of competitive long-distance running, Mandy DiMarzo was posting the kind of times that won races and finally felt on top of her game.

She had already competed in nearly a half-dozen marathons, including the 2005 Charlottesville (Va.) Marathon, where she was the first woman to cross the finish line, and the 2006 Boston Marathon, where her three hour, six minute finishing time put her among the top 100 female finishers.

With her eyes set on other races, this Old Greenwich resident continued to train, typically running about 70 to 80 miles a week -- that is, until a stress fracture in her thigh bone in 2010 revealed a condition that had previously remained undetected. DiMarzo had become one of the 34 million Americans estimated to have low bone density, also referred to as osteopenia. This condition increases her risk of developing osteoporosis, a disease that makes bones less dense, more fragile and more prone to fracture.

Her foundation was slowly weakening -- a condition brought on by an "energy deficient" diet. By relying too heavily on carbohydrates and failing to take in the proper amount of protein, healthy fats and dairy, she was not giving herself the proper fuel to maintain her vigorous activity or build strong bones.

"It came out of nowhere," DiMarzo said, recalling the moment two years ago when she was told she was going to have to stop running for about six weeks to allow her injury to heal.

The extent of her problem was further revealed during her followup visit. Even after six weeks, her bone had yet to heal.

The importance of taking in a proper diet when you are younger, which includes enough calcium and Vitamin D (important materials for bone's building blocks), and other vitamins and minerals, means one can reduce the risk of developing osteoporosis later in life.

It is the kind of advice that DiMarzo received once she started working with Dr. Marci Goolsby, a women's sports medicine doctor at Hospital for Special Surgery Affiliated Physician Office in Greenwich, who specializes in stress fractures and bone health in young athletes.

She narrowed in on DiMarzo's diet and her training schedule and asked her about any hormonal changes. Goolsby said a decrease in the frequency or an absence of a woman's period can signal an imbalance between calories in and calories out is.

This interplay between the nutritional, hormonal and skeletal impact is known as female athlete triad, or triad for short. "Essentially, it is the relationship between our energy balance, our menstrual cycle and our bone health," Goolsby said.

In DiMarzo's case, she was expending more calories than she was taking in, and that imbalance over the years had taken its toll.

With increased awareness and more women competing in sports, Goolsby said medical professionals not only have to look for signs of an imbalance, but also should help educate athletes of all ages on ways to protect one's bones, particularly since one typically cannot "feel" their bones becoming weaker, until, of course, something breaks.

Goolsby worked with DiMarzo, establishing a nutrition plan that introduced more proteins, healthy fats, dairy (yogurt, cottage cheese and milk), vegetables, a multivitamin, calcium and Vitamin D. She also began to spread out her workouts, focusing on cross-training and increasing her flexibility.

For DiMarzo, her tale ended well. Within a few months after making the changes in her diet and adding yoga and swimming to her exercise regimen, a bone density test revealed her bones had bounced back.